@layout("/common/_form.html",{js:["/assets/legalAidInfo/legalAidInfo_edit.js"]}){

<form class="layui-form" id="legalAidInfoForm" lay-filter="legalAidInfoForm">
    <div class="layui-fluid" style="padding-bottom: 75px;">
        <div class="layui-card">
            <div class="layui-card-header">基本信息</div>
            <div class="layui-card-body">
                <div class="layui-form-item layui-row">
                    <input name="id" type="hidden"/>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">分类<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="region" name="region" placeholder="请选择公司分类" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">所属区域<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="classify" name="classify" placeholder="请选择公司区域" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">公司名称<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="name" name="name" placeholder="请输入公司名称" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">联系电话<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="phone" name="phone" placeholder="请输入联系电话" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">联系地址<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="address" name="address" placeholder="请输入联系地址" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">擅长领域<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="field" name="field" placeholder="请输入擅长领域" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">实名认证<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="realNameAuthentication" name="realNameAuthentication" placeholder="请输入实名认证" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">执业认证<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="practiceCertification" name="practiceCertification" placeholder="请输入执业认证" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">平台认证<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="platformCertification" name="platformCertification" placeholder="请输入平台认证" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">简介<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="introduction" name="introduction" placeholder="请输入简介" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">执业年限<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="practiceYears" name="practiceYears" placeholder="请输入执业年限" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                </div>
            </div>
        </div>
    </div>
    <div class="form-group-bottom text-center">
        <button class="layui-btn" lay-filter="btnSubmit" lay-submit>&emsp;提交&emsp;</button>
        <button type="reset" class="layui-btn layui-btn-primary" ew-event="closeDialog">&emsp;取消&emsp;</button>
    </div>

</form>

@}